Abnormal glucose tolerance testing following gastric bypass demonstrates reactive hypoglycemia

Roslin, Mitchell; Damani, Tanuja; Oren, Jonathan H.; Andrews, Robert; Yatco, Edward; Shah, Paresh

doi:10.1007/s00464-010-1489-9

Cited by 84 publications

(65 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…assessed the incidence of hypoglycemia in 36 patients at six postoperative months of Roux-en-Y gastric bypass or more; those authors used a test with 100 g dextrosol and hourly blood glucose and insulin measurements over the course of four hours. More than two-thirds (72%) of the patients showed hypoglycemia (blood glucose ≤ 60 mg/ dL); the lowest glucose level found was 32 mg/dL (9). Adverse effects such as flushing, palpitations, nausea, sweating and diarrhea were observed in all eight post-bariatric surgery patients in another study, in which the OGTT was performed with 100 g dextrosol administered prior to, and three months after, surgery with the aim of comparing the levels of glucose, insulin, vasoactive intestinal peptide and neurotensin at those two timepoints (18).…”

Section: Discussionmentioning

confidence: 93%

“…However, most OGTT studies are not recent and fail to take into account the new clinical reality: the large number of indications of this test for patients who underwent bariatric surgery, both for the re-evaluation of the glycemic metabolism status after surgery (8) and for screening of gestational diabetes. It is known that the remission rates of type 2 diabetes after bariatric surgery orbit around 80% (9) and there occurs a significant improvement in fertility as well as in the polycystic ovary syndrome in women (10).…”

Section: Introductionmentioning

confidence: 99%

“…Four studies used the OGTT in the evaluation of bariatric surgery patients with hypoglycemia, with different loads of dextrosol administered (some used 75 g dextrosol, others, 100 g) (9,14,17,18). None of these studies was intended to describe adverse effects that might be observed during the test; rather, their aim was to investigate the likely causes of hypoglycemia by measuring related parameters, such as blood glucose, insulin, C-peptide and glucagon-like peptide type 1 (GLP-1).…”

Section: Introductionmentioning

confidence: 99%

“…None of these studies was intended to describe adverse effects that might be observed during the test; rather, their aim was to investigate the likely causes of hypoglycemia by measuring related parameters, such as blood glucose, insulin, C-peptide and glucagon-like peptide type 1 (GLP-1). Nearly all of those studies were conducted under medical supervision (9). Various authors who studied glycemic behavior in patients operated on by Roux-en-Y gastric bypass chose to use mixed meals, with lower carbohydrate concentrations than the standard dextrosol tests, probably to prevent the signs and symptoms of the dumping syndrome and reactive hypoglycemia, which can negatively impact an individual's social life (19,20,21).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Adverse effects during the oral glucose tolerance test in post-bariatric surgery patients

Andrade¹,

Pedrosa²,

Diniz³

et al. 2016

Arch. Endocrinol. Metab.

View full text Add to dashboard Cite

Objective: The oral glucose tolerance test (OGTT) is used in the screening of gestational diabetes, in diagnosis of type 2 diabetes in conjunction with fasting blood glucose and glycated hemoglobin. The aim of this study was to examine the incidence and risk factors of adverse effects of OGTT in patients who underwent bariatric surgery, in addition to proposing standardization for ordering the OGTT in these patients. Subjects and methods: This study assessed the incidence of adverse effects in 128 post-bariatric surgery patients who underwent the OGTT. Descriptive and logistic regression analysis were performed, the dependent variables were defined as the presence of signs (tremor, profuse sweating, tachycardia), symptoms (nausea, diarrhea, dizziness, weakness), and hypoglycemia (blood glucose ≤ 50 mg/dL). Results: One hundred and seventeen participants (91.4%) were female; 38 (29.7%) participants were pregnant. High incidence (64.8%) of adverse effects was observed: nausea (38.4%), dizziness (30.5%), weakness (25.8%), diarrhea (23.4%), hypoglycemia (14.8%), tachycardia (14.1%), tremor (13.3%), profuse sweating (12.5%) and one case of severe hypoglycemia (24 mg/dL). The presence of signs was associated with hypoglycemia (OR = 8.1, CI 95% 2.6-25.1). The arterial hypertension persisted as a risk factor for the incidence of signs (OR = 3.6, CI 95% 1.2-11.3). Fasting glucose below 75 mg/dL increased the risk of hypoglycemia during the test (OR = 9.5, CI 95% 2.6-35.1). Conclusion: In this study, high incidence of adverse effects during the OGTT was observed in post-bariatric surgery patients. If these results are confirmed by further studies, the indication and regulation of the OGTT procedure must be reviewed for these patients. Arch Endocrinol Metab.2016;60(4):307-13

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Adverse effects during the oral glucose tolerance test in post-bariatric surgery patients

Andrade¹,

Pedrosa²,

Diniz³

et al. 2016

Arch. Endocrinol. Metab.

View full text Add to dashboard Cite

show abstract

“…When 36 unselected patients at least 6 months postoperative from GBP were examined by 100 g oral glucose liquid load, 69% showed glucose values !3.3 mmol/l at 120 min, suggestive of reactive hypoglycemia (12). A case report in which food was administered in the empty gastric remnant via gastrostomy abolished gastrointestinal discomfort (13), emphasizing the importance of an intact pyloric function and duodenal passage to avoid dumping and excessive gut hormonal responses.…”

Section: Introductionmentioning

confidence: 99%

GLP1 analogs as treatment of postprandial hypoglycemia following gastric bypass surgery: a potential new indication?

Abrahamsson¹,

Engström

Sundbom

et al. 2013

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: The number of morbidly obese subjects submitted to bariatric surgery is rising worldwide. In a fraction of patients undergoing gastric bypass (GBP), episodes with late postprandial hypoglycemia (PPHG) develop 1-3 years after surgery. The pathogenesis of this phenomenon is not fully understood; meal-induced rapid and exaggerated increases of circulating incretins and insulin appear to be at least partially responsible. Current treatments include low-carbohydrate diets, inhibition of glucose intestinal uptake, reduction of insulin secretion with calcium channel blockers, somatostatin analogs, or diazoxide, a K ATP channel opener. Even partial pancreatectomy has been advocated. In type 2 diabetes, GLP1 analogs have a well-documented effect of stabilizing glucose levels without causing hypoglycemia. Design: We explored GLP1 analogs as open treatment in five consecutive GBP cases seeking medical attention because of late postprandial hypoglycemic symptoms. Results: Glucose measured in connection with the episodes in four of the cases had been 2.7, 2.5, 1.8, and 1.6 mmol/l respectively. The patients consistently described that the analogs eliminated their symptoms, which relapsed in four of the five patients when treatment was reduced/discontinued. The drug effect was further documented in one case by repeated 24-h continuous glucose measurements.Conclusion: These open, uncontrolled observations suggest that GLP1 analogs might provide a new treatment option in patients with problems of late PPHG.

show abstract

Comparison of the Performance of Common Measures of Weight Regain After Bariatric Surgery for Association With Clinical Outcomes

King

Hinerman

Belle

et al. 2018

JAMA

262

217

View full text Add to dashboard Cite

IMPORTANCE Estimates of weight regain following bariatric surgery vary widely. OBJECTIVE Describe weight regain following post-Roux-en-Y gastric bypass (RYGB) weight nadir, and compare common weight regain measures for association with clinical outcomes. SETTING Ten hospitals in six US cities: Portland, OR, Seattle, WA, Fargo, ND, Pittsburgh, PA, New York, NY and Greenville, NC. DESIGN AND PARTICIPANTS Adults undergoing bariatric surgical procedures entered a prospective cohort study between February 2006-February 2009 (N=2458) and completed pre-surgery, six month and annual assessments for up to seven years through January 2015. Participants who underwent RYGB and were followed ≥5 years with ≥5 weight measurements were included (83%; 1406 of 1703, excluding deceased/reversals). EXPOSURE Weight regain assessed by five continuous measures (kg, body mass index [BMI; kg/m2], % pre-surgery weight, % nadir weight and % maximum weight loss) and eight dichotomous measures (per established thresholds) were compared in relation to clinical outcomes based on statistical significance, magnitude of association and model fit. MAIN OUTCOME MEASURES Progression of diabetes, hyperlipidemia, and hypertension, and declines in physical and mental health-related quality of life, and satisfaction with surgery. RESULTS Medians (25th–75thpercentiles) are reported. Pre-surgery age was 47 years (38–55) and BMI was 46.3 (42.3–51.8). Most participants were female (80.3%) and white (84.9%). Follow-up was 6.6 (5.9–7.0) years. Maximum weight loss was 37.4% (31.6%−43.3%) of pre-surgery weight, occurring 2.0 (1.0–3.2) years post-surgery. The rate of weight regain was highest in the first year following weight nadir, but regain continued across follow-up, ranging from 9.5% (4.7%−17.2%) to 26.8% (16.7%−41.5%) of maximum weight lost, one to five years post-nadir. The % participants who regained weight depended on threshold (e.g., five years post-nadir, 43.6% regained ≥5 BMI points, 50.2% regained ≥15% of nadir weight and 67.3% regained ≥20% of maximum weight lost). Percentage of maximum weight lost vs. other continuous weight regain measures, had the strongest associations with, and best model fits for, all outcomes except hyperlipidemia, which had a slightly stronger association with regain in BMI. Of dichotomous measures, ≥20% of maximum weight lost performed best with all outcomes except hyperlipidemia and satisfaction (≥10 kg and ≥25% of maximum weight lost were superior, respectively). CONCLUSIONS Among a large cohort of adults who underwent RYGB, weight regain quantified as percentage of maximum weight lost performed better for association with most clinical outcomes than the alternatives examined. These findings may inform standardizing measurement of weight regain in studies of bariatric surgery.

show abstract

Abnormal glucose tolerance testing following gastric bypass demonstrates reactive hypoglycemia

Cited by 84 publications

References 35 publications

Adverse effects during the oral glucose tolerance test in post-bariatric surgery patients

Adverse effects during the oral glucose tolerance test in post-bariatric surgery patients

GLP1 analogs as treatment of postprandial hypoglycemia following gastric bypass surgery: a potential new indication?

Comparison of the Performance of Common Measures of Weight Regain After Bariatric Surgery for Association With Clinical Outcomes

Contact Info

Product

Resources

About